Provider Demographics
NPI: | 1366425274 |
---|---|
Name: | IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION |
Entity type: | Organization |
Organization Name: | IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT, IPCMF |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | PATRICIA |
Authorized Official - Middle Name: | K |
Authorized Official - Last Name: | NEWLAND |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 515-285-3200 |
Mailing Address - Street 1: | PO BOX 843151 |
Mailing Address - Street 2: | |
Mailing Address - City: | KANSAS CITY |
Mailing Address - State: | MO |
Mailing Address - Zip Code: | 64184-3151 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 888-434-4165 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1776 W LAKES PKWY STE 400 |
Practice Address - Street 2: | |
Practice Address - City: | WEST DES MOINES |
Practice Address - State: | IA |
Practice Address - Zip Code: | 50266-8378 |
Practice Address - Country: | US |
Practice Address - Phone: | 515-471-9300 |
Practice Address - Fax: | 515-471-9319 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2005-11-23 |
Last Update Date: | 2025-04-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
207Q00000X, 207R00000X, 207RC0000X, 207RG0100X, 207RI0200X, 207RP1001X, 207RR0500X, 207V00000X, 208000000X, 208100000X, 2084N0400X, 208600000X, 208M00000X, 208D00000X | ||
IA | 1100240058 | 332B00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Multi-Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
No | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IA | CC6519 | Other | RR MEDICARE |
IL | CJ3564 | Other | RR MEDICARE |
IA | CC6757 | Other | RR MEDICARE |
IA | CC7716 | Other | RR MEDICARE |
IA | CI6362 | Other | RR MEDICARE |
IA | 0141010 | Medicaid | |
IL | 200715 | Medicare PIN | |
IA | 0141010 | Medicaid |